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PubMed1990

[Prevention of classical risk factors. A public health and health policy task].

Epidemiologic cohort studies such as Framingham, Tecumseh, Evans County and the Multiple Risk Factor Intervention Trial Cohort Study have shown, that hypercholesterolemia, hypertension and cigarette smoking are the strongest predictors for cardiovascular diseases and especially for coronary heart disease. From the intervention studies of the last two decades it has been learn that reductions of the risk factors hypercholesterolemia and hypertension have led to the predicted reductions in cardiovascular and all cause mortality. Two strategies are available for the prevention of hypercholesterolemia and hypertension: The population strategy and the high risk strategy. With regard to cholesterol and blood pressure the population approach strives for the shifting of the respective population distributions to the left i.e. to lower values. The high risk strategy on the other hand restricts itself to the 10-20% of the population with very high values. A comparison of the population and high risk strategy shows, that only the population strategy is radical in that only this strategy is capable to eliminate the causes of the incidence of hypercholesterolemia and hypertension. The high risk strategy on the other hand is unable to influence the total distribution curve. Population strategy and high risk strategy should be seen as complementary. To further reduce mortality and morbidity from cardiovascular diseases in the Federal Republic of Germany the following public health programs and health policy strategies must be applied: a) Reinforcement of the National High Blood Pressure Education Program. b) Establishment of a National High Cholesterol Education Program. c) Nationwide Anti-smoking Campaigns and Programs.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteriosclerosis↗
PubMed2000

Virtual university applied to telesurgery: from teleeducation to telemanipulation.

UNLABELLED: PROBLEM/BACKGROUND: In order to improve patient care by minimal invasive surgery (MIS), we perfected a Virtual TeleSurgical University that allows for teleeducation, teleconcertation, surgical planning and telemanipulation, through new Virtual Reality and multimedia systems. TOOLS AND METHODS: The organization of this innovative school was federated around three major research programs. First, the TESUS program focused on the teletransmission of medical information, allowing for videoconferencing around the world and telementoring. Next, the WeBS-Surg program is a multimedia continuous surgical education system on internet, that allows for teleeducation and teleconcertation between world experts in MIS. Then, the MASTER program (Minimal Access Surgery by Telecommunications and Robotics) allowed the development of the third millenium Operating room. It included Virtual Reality systems that delineate automatically anatomical and pathological structures of a patients from him CT-scan, and that allow for an interactive surgical planning and force-feed-back simulation. It also included a telesurgical robot named Zeus controlled by surgeons through telemanipulation system. RESULTS: Tests and validation shows that all these systems improved all steps of the surgical procedure: preoperatively due to a better continuous education and a computer assisted surgical planning, and peroperatively due to teleconcertation, telementoring and telemanipulation systems. CONCLUSION: Revolutionary tools for minimal invasive surgery learning, planning and performing are all ready available. These tools represents the first prototype of the computer assisted tele-robotical surgery that will be the future of surgery.

Computer Simulation↗
PubMed2000

Effects of traditional classroom and distance continuing education: a theory-driven evaluation of a vaccine-preventable diseases course.

OBJECTIVES: This study evaluated the effects of a major federal immunization continuing education course, delivered in both traditional classroom and satellite broadcast versions, on public health professionals' knowledge, agreement, self-efficacy, and adherence in practice to recommendations. METHODS: The study used a comparative time series design to determine whether the course influenced participants' knowledge, agreement, self-efficacy, and adherence in practice to general and polio-specific recommendations as measured immediately and 3 months after the course. It also compared the effects of the classroom and satellite broadcast versions and used path analysis to show how the outcomes were related to one another. RESULTS: Both versions significantly improved knowledge, agreement, self-efficacy, and adherence. Knowledge and agreement were significant predictors of self-efficacy, which directly predicted adherence. Vaccine availability and supportive clinic policies were also important adherence predictors. CONCLUSIONS: A well-designed training update can change provider knowledge, agreement, self-efficacy, and adherence. Traditional classroom and distance training can have comparable effects. The findings support incorporation of distance learning in national public health training, if the distance learning is used wisely in relation to training needs, goals, and practice contexts.

Analysis of Variance↗
PubMedDate not supplied

DDT in human milk and mental capacities in children at school age: an additional view on PISA 2000.

OBJECTIVES: To investigate a possible lasting impact of dichlorodiphenyl trichloroethane (DDT) exposure in neonatal life on mental capacities in later life. MATERIAL AND METHODS: Relationships were evaluated by correlation and regression analysis between total DDT concentrations in human breast milk in the years of birth (1984/1985) and measurements of mental capacities obtained in pupils of the PISA 2000 studies as well as percentages of backward children in Germany in 1994/95. RESULTS: Comparing total DDT levels in human milk during the years of birth (1984/85) evaluable for eleven PISA countries with assessed mental capacities of 15-year-old pupils of PISA International, a significant inverse correlation was found (p < 0.001), even after adjustment for socioeconomic statuses (p = 0.001). Furthermore, a significant inverse correlation (p < 0.001) was also obtained between the total DDT concentrations in human milk in 1984/85 in ten foreign countries of three continents plus fourteen Federal States of Germany and the mental capacities of 15 year-old pupils of PISA International plus PISA National (Germany) 2000. Finally, a significant positive correlation was observed between total DDT contents in human milk in 1984/85 and the percentages of backward school children in 1994/95 in Federal States of Germany (p < 0.001). CONCLUSIONS: These data in association with additional experimental and epidemiological findings suggest that DDT is a "neuroendocrine disrupter" as well as a "functional teratogen" leading to harmful effects on brain development and mental capacities in later life. Thus, a neuroendocrine prophylaxis during critical developmental periods in early life as recommended by our group since many years appears to be most important for primary preventive medicine but even for "preventive pedagogics". The validity of these theses should be re-tested in future PISA studies.

Adolescent↗
PubMed1990

The family physician's role with parents of young children with developmental disabilities.

Technological advances, coupled with recent federal legislation targeting young children who have developmental disabilities, will increasingly necessitate an expanded role of the family physician in the lives of these children and their families. Of particular importance is Public Law 99-457, the Education of the Handicapped Act Amendments of 1986, which recognizes the importance of the family unit in any intervention methodology that may be provided. This legislation also notes that the active involvement of the family's physician is desirable when designing services appropriate for children with developmental disabilities and their families. Providing support and optimizing positive family interactions are crucial to these children. Recommendations to enable the family physician to address more effectively the unique needs of this patient population include (1) an informal screening protocol, and (2) communication skills that include talking with both parents at the same time, using accurate, nonstigmatizing language when presenting a diagnosis, showing acceptance of and optimism regarding the child, encouraging parents to explain their child's problems to others, helping parents to learn about their children's unique needs, and helping parents to understand how their attitudes affect their child.

Child, Preschool↗
PubMed2001

From the primary care organizations consortium's proposal to the Interdisciplinary Generalist Curriculum Project.

The Interdisciplinary Generalist Curriculum (IGC) Project was one element of an overall federal government strategy designed to promote primary care education. This project, undertaken by the Division of Medicine and Dentistry (DMD), Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services, was the first large-scale medical education contract initiated by DMD. The IGC Project was based on a model proposed by the Primary Care Organizations Consortium (PCOC). The PCOC thesis was that "if students are to decide to pursue a generalist career they must have the opportunity to be taught by generalists." The PCOC Program required an explicit curriculum focusing on generalist knowledge and skills with an emphasis on technology, in the context of education that required training in ambulatory office-based settings. The PCOC Program specified that responsibility for the program's planning, implementation, and evaluation be shared by the three generalist physician faculties of family medicine, general internal medicine, and general pediatrics. In implementation of this demonstration project in ten medical schools across the nation, several lessons have been learned relative to enhancement of generalist education. Among these lessons is that seed money targeted to initiate modest change can act as a catalyst and improve the knowledge and skills afforded medical students concerning generalist practice. Limited funds provided over a sufficient period of time can induce schools to undertake significant curricular change.

Curriculum↗
PubMed2004

The language divide. The importance of training in the use of interpreters for outpatient practice.

PURPOSE: Provision of interpreter services for non-English-speaking patients is a federal requirement. We surveyed clinicians to describe their experience using interpreters. SUBJECTS AND METHODS: In this cross-sectional study we surveyed clinicians in three academic outpatient settings in San Francisco (N = 194) regarding their most recent patient encounter which involved an interpreter. Questions about the visit included type of interpreter, satisfaction with content of clinical encounter, potential problems, and frequency of need. Previous training in interpreter use, languages spoken, and demographics were also asked. Questionnaires were self-administered in approximately 10 minutes. RESULTS: Of 194 questionnaires mailed, 158 were completed (81% response rate) and 67% were from resident physicians. Most respondents (78%) were very satisfied or satisfied with the medical care they provided, 85% felt satisfied with their ability to diagnose a disease and treat a disease, but only 45% were satisfied with their ability to empower the patient with knowledge about their disease, treatment, or medication. Even though 71% felt they were able to make a personal connection with their patient, only 33% felt they had learned about another culture as a result of the encounter. Clinicians reported difficulties eliciting exact symptoms (70%), explaining treatments (44%), and eliciting treatment preferences (51%). Clinicians perceived that lack of knowledge of a patient's culture hindered their ability to provide quality medical care and only 18% felt they were unable to establish trust or rapport. Previous training in interpreter use was associated with increased use of professional interpreters (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.4 to 7.5) and increased satisfaction with medical care provided (OR, 2.6; 95% CI, 1.1 to 6.6). CONCLUSIONS: Clinicians reported communication difficulties affecting their ability to understand symptoms and treat disease, as well as their ability to empower patients regarding their healthcare. Training in the use of interpreters may improve communication and clinical care, and thus health outcomes.

Adult↗
PubMed1997

Panax ginseng pharmacology: a nitric oxide link?

Panax ginseng is used in traditional Chinese medicine to enhance stamina and capacity to cope with fatigue and physical stress. Major active components are the ginsenosides, which are mainly triterpenoid dammarane derivatives. The mechanisms of ginseng actions remain unclear, although there is an extensive literature that deals with effects on the CNS (memory, learning, and behavior), neuroendocrine function, carbohydrate and lipid metabolism, immune function, and the cardiovascular system. Reports are often contradictory, perhaps because the ginsenoside content of ginseng root or root extracts can differ, depending on the method of extraction, subsequent treatment, or even the season of its collection. Therefore, use of standardized, authentic ginseng root both in research and by the public is to be advocated. Several recent studies have suggested that the antioxidant and organ-protective actions of ginseng are linked to enhanced nitric oxide (NO) synthesis in endothelium of lung, heart, and kidney and in the corpus cavernosum. Enhanced NO synthesis thus could contribute to ginseng-associated vasodilatation and perhaps also to an aphrodisiac action of the root. Ginseng is sold in the U.S. as a food additive and thus need not meet specific safety and efficacy requirements of the Food and Drug Administration. Currently, such sales amount to over $300 million annually. As public use of ginseng continues to grow, it is important for this industry and Federal regulatory authorities to encourage efforts to study the efficacy of ginseng in humans by means of appropriately designed double-blind clinical studies.

Animals↗
PubMed2005

Impact of the recent reduction in working hours (the 80 hour work week) on surgical resident cancer education.

BACKGROUND: Resident work hours were recently reduced to 80 hours per week by a mandate from the Accreditation Council for Graduate Medical Education and subsequent Federal law (HR 3236). This mandate became effective July 1st, 2003. We sought to determine any impact this change had on perceived and real resident cancer education and knowledge. METHODS: Of the total 85 residents in our large, university-based surgical training program, we focused on the 40 who had been in the clinical program (rather than research) before and after the work hour reduction. Perceived impact on cancer education was determined by survey, and real impact by before (2002) and after (2004) scores on the overall and cancer-specific portion of the annual American Board of Surgery In-Training Examination (ABSITE). RESULTS: All eligible residents responded to the survey. The majority (83% to 85%) indicated that exposure to cancer patients on wards and in clinics remained the same. Thirty percent felt that their exposure to cancer operations and tumor boards had decreased; 60% to 65% felt that exposure to these activities were unchanged. Approximately half of residents reported an increase in their cancer-related reading and Internet learning activities--the other half felt they had not changed. The majority (88%) reported no change in their participation in extraprogrammatic cancer-related continuing medical education activities. Of the survey responders, 23 had completed the ABSITE in both 2002 and 2004; their mean scores between the 2 time periods increased by 7% for the overall test and decreased by 3% for the cancer-specific portion. CONCLUSIONS: Overall, the recent reduction in work hours does not appear to have changed residents' experience with cancer patient care, although possible early reductions in attendance at cancer operations and tumor boards merits further study and possibly future schedule changes. The reported perceived increase in cancer-related reading and Internet learning has not yet translated into improved test scores.

Educational Measurement↗
PubMed1991

Overview of allied health personnel shortages.

Upon learning that 95% of all fatal traffic accidents occur within three miles of one's home, an acquaintance moved to another residence four miles away and is still alive today. The world might be a much better place if most obstacles could be overcome this handily. Unfortunately, the problem of allied health personnel shortages appears to be more intractable. Because the situation is complicated in nature, it is most unlikely that any single remedy will suffice. Public and private interests have joined forces in many states, but it is abundantly clear that conventional market forces are unlikely to prevail. These forces usually focus on supply and demand. While shortages may cause entry-level salaries to rise, they do not stimulate academic institutions to increase their output nor will they affect the availability of research funding and/or doctoral training programs. Current market forces compel health facilities to engage in bidding wars for scarce manpower. Although individual job seekers may benefit, this practice does not increase the number of training program graduates. The federal government has a decisive role to play in assuring an adequate number of personnel to meet this nation's health care needs. Assistance is necessary in the form of providing entry- and advanced-level traineeships to accelerate the flow of part-time students pursuing doctorates, and to fund model student recruitment/retention projects. This role should encompass attracting students (particularly from minority and underserved portions of the population) to academic programs. The Disadvantaged Minority Health Improvement Act, PL 101-527 that was enacted in November 1990, contains only minimal provisions for allied health. Eligibility for student scholarship assistance is restricted to a small handful of allied health professions. Moreover, allied health is not eligible for the loan repayment program aimed at individuals who agree to serve on the faculty of health professions schools that historically train individuals from disadvantaged backgrounds. It is difficult to envision how serious underrepresentation of minorities in allied health will be affected by this legislation. Clearly, special consideration by the federal government is required to produce a cadre of allied health caregivers drawn from the ranks of those whom they serve. Allied health research is needed to expand the basis for practice, increase knowledge, and generate studies pertaining to the efficacy of practice. Funding is required to support the development of scholars and scholarship in allied health institutions to ensure a pool of qualified faculty members. Finally, many difficulties result from a lack of governmental visibility.(ABSTRACT TRUNCATED AT 400 WORDS)

Allied Health Personnel↗
PubMed2000

[Teaching physical pulmonary examination through the problem-based method].

Action-research was accomplished at the Federal University of Goiás College of Nursing in 1998 aiming at implementing and analyzing the teaching resources of physical pulmonary examination through the problem-based method. The Arch Method Phases were developed with sophomores in the undergraduate Nursing Course. During the Conclusion Hypothesis phase, the need of various activities in order to fix the theme was observed. In the theoretical and psycho-motor evaluation, we verified that the students had more difficulty in performing percussion and palpitation. It was concluded that the application of the problem-based pedagogy in physical examination was feasible.

Education, Nursing↗
PubMed1999

An interdisciplinary national program developed at Baylor to make science exciting for all K-5 students.

The achievement gap in science begins in elementary school, where many students lose interest in science-related studies, particularly students from traditionally underrepresented groups. The "My Health My World" Project (hereafter, "the Project"), developed at Baylor College of Medicine with the assistance of federal funds, is a national effort to address this problem. The Project's goals are to make science appealing and relevant for elementary school students (i.e., kindergarten through grade five), including those from underrepresented minorities (URMs), and easy to teach for teachers and parents. It is achieving this goal by the development of interdisciplinary instructional materials that use environmental health issues as a unifying theme. The Project provides its materials (including take-home materials for parents) and training for teachers at seven dissemination centers across the country, established in 1997. Workshops are also held to train facilitators, chosen from among local science education leaders, who in turn hold workshops to train other teachers. Each center receives a mini-grant to cover costs related to the training it provides, and all coordinate their training to offer comparable experiences for all participants. Field tests in 1995, 1996, and 1997 involving culturally, racially, and ethnically diverse students and teachers in two sites indicate that the participating teachers found that the Project's materials promote science learning and enthusiasm for science and are easy to use and engaging for teachers. Ratings for workshops in 1998 were also high for all characteristics evaluated. All signs after the Project's first full year of dissemination activities (1998) indicate that it will continue to reach more teachers and students across the nation and will eventually help more students from all backgrounds achieve in science-related studies.

Child↗
PubMedDate not supplied

Enhancing cognition in the intellectually intact.

As science learns more about how the brain works, and fails to work, the possibility for developing "cognition enhancers" becomes more plausible. And the demand for drugs that can help us think faster, remember more, and focus more keenly has already been demonstrated by the market success of drugs like Ritalin, which tames the attention span, and Prozac, which ups the competitive edge. The new drug Aricept, which improves memory, most likely will join them. Whether such drugs are good for individuals, or for society, is an open question, one that demands far more public discussion.

Brain Diseases↗
PubMedDate not supplied

Healthy children ready to learn: an essential collaboration between health and education.

The "Healthy Children Ready to Learn" initiative starts with the underlying concept that health is a critical partner to optimum education. All children have a right to be healthy. At a minimum, this right assumes promoting optimum use of available and effective preventive measures, such as ensuring compliance with immunization recommendations; promoting measures to prevent injuries; ensuring opportunities to identify disease and disabilities early; and providing prompt treatment when needed. Families must receive the support and assistance they need to raise healthy and educated children. Activities directed toward National Education Goals and the related National Health Promotion and Disease Prevention Objectives can advance progress toward school readiness, focus attention and available resources on needed programs and services, and thus help the nation in achieving its goal of having all children arriving at school each day healthy, well nourished, and ready to learn. To realize these goals and objectives, the two critical systems of greatest importance to children, those providing health services and education, need to collaborate, not only among themselves, but also with social services. A range of critical health problems will require our attention if the goals are to be met, such as availability of prenatal care, infant mortality, inadequate nutrition during pregnancy or early childhood, or both, disease prevention by immunization, infants who have been exposed to drugs, fetal alcohol syndrome, and the emotional and mental disorders of early childhood, to name a few. At any one time, any family may be in need of appropriate services. To address the health and well-being of their young children, a continuum of appropriate, accessible services must be available in the community. The first steps toward successful achievement of the readiness goal will require the identification of health, education, and social service programs that serve young children and their families, and the creation of a climate that fosters innovative and effective collaboration between programs at the Federal and State levels, especially as it pertains to the community. Policies and programs should be built around the needs of families. In this regard, the critical role that parents play in shaping a healthy environment conducive to school readiness must be recognized as a key element in shaping the strategies that should help in achieving the readiness goal. Similarly important is the need to engage professional organizations and other private sector groups involved with health, education, and other children's issues to work with government and families to achieve the school readiness goal and its related health objectives.

Adolescent↗
PubMed2005

[How many procedures are necessary to achieve competency in colonoscopy?].

BACKGROUND: Competency for colonoscopy implies technical and cognitive skills. The American Society for Gastrointestinal Endoscopy has suggested 100 supervised procedures might be necessary. There are no specific recommendations in Brazil. AIM: To evaluate technical progress of trainees during a regular colonoscopy training program. MATERIALS AND METHOD: Two gastrointestinal fellows at Federal University of São Paulo, SP, Brazil, were prospectively evaluated during first year training. The frequency and time of reaching the cecum, total procedure duration, ability to identify lesions and patient discomfort were recorded. RESULTS: Two hundred and seventy one colonoscopies were preformed by both fellows (fellow A: 186 and B: 85). Twenty-seven cases were excluded of obstructive lesions or previous surgery, leading 171 and 72 exams, respectively. The mean success rate of reaching the cecum was 82.5% and 56.9%, respectively. For the first 72 exams it was 72.2% and 56.9%. Fellow A reached the cecum in 76% of first 100 colonoscopies, improving to 91.5% after the 101 st. Mean time for trainees to complete the procedure was 17.7 and 23.5 minutes to fellows A and B. Trainee A took 19.8 and 14.7 minutes before and after the 100th colonoscopy. DISCUSSION: Success rate and time taken to reach the cecum progressively improved over the number of procedures with statistical significance. However, because of individual differences, 100 colonoscopies may be insufficient to acquisition of technical skills. CONCLUSION: Although analyzing the learning curve of two fellows only, we could notice a statistically significant improve in reaching the cecum with experience over time. However, depending on individual skills more than 100 procedures may be necessary during training.

Clinical Competence↗
PubMed1991

[Predictive value of psychiatric symptoms in the preschool age for adjustment in school age].

This paper derives from a prospective cohort study conducted in Freiburg (Federal Republic of Germany) from 1979 to 1987 with 209 (follow-up outcome: 172) 3- to 5-year-olds. The "Behaviour-Screening Questionnaire," the "Children's Global Assessment Scale" and a thorough semi-standardized interview were used to identify behavior problems in the children. The results were analyzed in relation to life events, sex and socioeconomic status. They were compared with the findings in other studies. Most of the variables examined proved to be of low predictive value. The mood changes common in preschool and kindergarten children with behavior problems were no longer in evidence 7 years later.

Child↗
PubMed2001

Managing waterway health in the Goulburn Broken Catchment, Victoria, Australia.

Historically within most catchments, resource management programs have been planned and implemented in isolation of one another. This was once the case in the Goulburn Broken Catchment, a major catchment of the Murray Darling Basin, Australia. Although only 2% of the Murray Darling Basin's land area, the catchment generates 11% of the basin's water resources. Learning from the past, a cooperative and collaborative approach to natural resource programs has developed. This approach is the envy of many other catchment communities and agencies. Through a combination of "Partnership Programs", "Operational Initiatives" and community involvement, significant programs have been implemented within the catchment, which will benefit not only the local community but communities further afield. The outcomes of the waterway health program highlight the benefits provided through the establishment of cooperative and partnership resource improvement programs. These programs were founded on the ability of the community to recognise the need for integration, base management decisions on best available science and an ability to work together. Their effective delivery has been provided through the resources provided, to the local community, by the Natural Heritage Trust with matching and State and local allocations. While programs have shown success, challenges still face the community. These challenges include verification and implementation of environmental flows, storage of the catchment's vital water resources, and maintaining community involvement and participation in on-going works programs. The Goulburn Broken Catchment community, with the support of Federal, State and Local Governments, is looking at opportunities for continued improvements in waterway health.

Conservation of Natural Resources↗
PubMed2004

A physician charter on medical professionalism: a challenge for medical education.

The European Federation of Internal Medicine, The American College of Physicians-American Society of Internal Medicine, and the American Board of Internal Medicine recently developed a Charter on Medical Professionalism that they hope will be accepted by physicians around the world. The charter is based on three principles: the primacy of patient welfare, patient autonomy, and social justice. We believe that each of these principles has relevance to medical education and practical implications. Based on the obligations of the charter, we believe that medical educators should consider the attribute of altruism in making admission decisions, enhance moral development in medical schools, develop a curriculum in quality improvement, explore further the use of patient simulation, and renew their efforts to incorporate knowledge of the basic sciences into clinical training. Furthermore, we believe they should ensure that students protect patient confidentiality, ensure role-model appropriate interactions with pharmaceutical companies, teach students how gender, race, and socioeconomic status have an impact on health care, require electives in underserved areas, and incorporate the charter into courses on medical ethics. Medical educators must also ensure that the curriculum and learning climate at their institutions support the values articulated in the charter.

Journal Article↗